Why Fibroids, Multiple Pregnancies Drive Postpartum Haemorrhage Risk in Nigeria – Expert Raises Alarm

Investigation highlights gaps in maternal care as PPH remains a leading cause of deaths despite preventable risk factors

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By A1 News International | Abuja, Nigeria

Postpartum haemorrhage (PPH), a life-threatening condition marked by excessive bleeding after childbirth, continues to claim thousands of lives globally and remains a major driver of maternal mortality in Nigeria.

An investigation by A1 News International reveals that beyond medical risk factors, systemic healthcare gaps and delayed access to skilled care are compounding the crisis.

According to the World Health Organization (WHO), an estimated 14 million women experience PPH annually, resulting in about 70,000 deaths worldwide.

In Nigeria, where maternal mortality remains among the highest globally, experts say the burden is worsened by weak healthcare infrastructure, low awareness, and reliance on unskilled birth attendants.

High-Risk Conditions Driving PPH
Speaking to PT Health Watch, consultant gynaecologist Sunday Olarewaju identified fibroids and multiple pregnancies as key factors increasing the risk of severe bleeding after delivery.

He explained that pregnancies involving twins or triplets overstretch the uterus, weakening its ability to contract effectively after childbirth.

Similarly, fibroids—non-cancerous growths in the womb—can disrupt normal uterine contraction, leaving blood vessels exposed and increasing the likelihood of prolonged bleeding.

“When the womb cannot contract properly, bleeding continues,” he said.

The ‘Four Ts’ of Maternal Risk
Medical professionals classify the causes of PPH using the “four Ts”: tone, tissue, trauma, and thrombin.

Tone: Failure of the uterus to contract after delivery
Tissue: Retained placenta or membranes
Trauma: Tears or injuries during childbirth
Thrombin: Blood clotting disorders

Experts say uterine atony—poor contraction—is the most common cause, particularly in cases involving prolonged labour or high-risk pregnancies.

Systemic Failures Beyond Medical Causes
While medical conditions increase vulnerability, findings indicate that many deaths are linked to delayed or inadequate care.

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Limited access to properly equipped health facilities, especially in rural areas, continues to push many women toward traditional birth attendants lacking emergency response capacity.

Olarewaju noted that prolonged labour, anaemia, and pre-existing conditions such as hypertension and diabetes further elevate risks—particularly when intervention is delayed.

“A woman who has prolonged labour is already exhausted, and the womb itself becomes weak,” he explained.

Access, Awareness, and Accountability
Health experts stress that most PPH-related deaths are preventable with early detection, skilled birth attendance, and functional referral systems.

However, Nigeria’s primary healthcare system remains under-resourced, with gaps in emergency obstetric care, blood supply, and trained personnel.

Investigations show that even where facilities exist, affordability, distance, and lack of awareness continue to limit utilisation.

Prevention Starts Before Delivery
Experts recommend early antenatal care, proper screening for high-risk conditions, and planned delivery in facilities equipped to handle emergencies.

Strengthening community awareness and improving referral systems are also seen as critical to reducing mortality rates.

“By strengthening basic health services and ensuring people use them, we will reduce maternal mortality,” Olarewaju said.

Despite growing awareness, postpartum haemorrhage remains a silent killer in Nigeria, driven by a combination of medical risks and systemic healthcare failures.

Addressing the crisis will require not just medical intervention, but sustained investment in healthcare infrastructure, public education, and policy accountability.